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Center for Intercultural Engagement and Support
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Center for Intercultural Engagement and Support
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Friendship Families
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Friendship Family Interest Form
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Home
»
Center for Intercultural Engagement and Support
»
Programs and Services
»
Friendship Families
»
Friendship Family Interest Form
Friendship Family Interest Form
*
= required field
Why do you and your family want to participate in the Friendship Family program
*
How do you think your student will benefit by becoming part of your family
*
Last name:
*
First name(s):
*
Home Address:
*
City:
*
State:
*
Zip code:
*
Phone Number:
*
Best time to reach you at home:
*
E-mail address:
*
Number of family members participating in the program:
*
Have your previously participated in Luther's Friendship Family Program?
*
Yes
No
Preferences:
We'd like you to share with us any information or preferences you have that will help us to match you with an international student.
I'd prefer a student who is:
Female
Male
No preference
I would be willing to outreach to my student (please check all that apply)
During Friendship Family events
During Fall Break
During Winter Break
During Spring Break
For holiday dinners
Please select the top 3 activities that are important to you and your family
*
Cooking
Sports
Arts
Shopping
Religion
Relaxing at home
Outdoor activities
Enjoying a good meal
Going out for coffee or ice cream
Other (please see below)
If Other please specify
Do you have any pets? if yes please specify
We/I would be interested in hosting more than one international student.
Yes
No
How did you hear about the program
Friends
Website
Diversity Today
Posters
Luther Tuesday
Radio
Newspaper
Other (please see below)
Have you ever been convicted of anything other than a traffic violation?
*
Yes
No
If Yes, please specify or contact the Center for Intercultural Engagement and Student Success
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